Visual aids for patients
Visual aids can help patients understand, remember and use health information when pictures are relevant to the words and the intended task. Selecting an image, explaining it and testing the aid with its users are separate parts of the work.
Effects on understanding and recall
A review of studies across health education, psychology, education and marketing found that pictures closely linked to written or spoken text can increase attention to and recall of health information compared with text alone. Pictures can improve comprehension when they show relationships among ideas or spatial relationships, and can change adherence to health instructions. All patients can benefit, particularly those with low literacy; very low-literacy readers may be helped by spoken directions with pictures to take home or pictures with simply worded captions.
Simple line drawings paired with text can engage readers more than text or graphics alone and avoid background distractions and overstimulation associated with more complex images. Drawings and pictographs such as stick figures can also be produced quickly and at low cost.
Treatment timelines
Pictogram-based timelines for patients with haematological neoplasms were developed to summarise complex treatment paths. A review of patient brochures during the project found roughly fifty-page PDFs with only two or three figures, often photographs of a nurse caring for a patient rather than explanations of treatment or disease.
Clinicians required the timeline to avoid specific calendar dates and communicate uncertainty, because treatment may change and a planned bed may not be available. The result was a flow chart with pictograms and short annotations, giving the treatment sequence at the minimum level patients wanted while clinicians had sought more detail.
A multiple-myeloma example encoded four stages through treatment type, setting and relative time.
| Stage | Labels and visual encoding in the example |
|---|---|
| Preparatory chemotherapy | Four cycles, each labelled with two types of pills and two types of injections; outpatient hospital consultation. |
| Blood-cell apheresis | Stem-cell mobilisation labelled as daily injections for four days. |
| Hospital stay | Approximately three weeks as an inpatient; high-dose chemotherapy and an own-stem-cell infusion labelled day 4. |
| Follow-up and maintenance | Follow-up at 8–12 weeks after the hospital stay and at least annual outpatient checks, with possible repetition of treatment. |
Testing pictures and the complete aid
The treatment-timeline project used three stages of evaluation: recognising the visual representations, testing comprehension with the aid, and evaluating its use in clinical practice.
Recognition and suitability
Three hundred volunteers compared pictograms, comics and photographs representing key terms. They were asked both whether an image’s meaning could be guessed without explanation, termed transparency, and whether it was suitable once its intended meaning was supplied. The experiment used an agreement threshold above 85%.
Photographs were recognisable for about half the terms and comics met the criterion for five of eight. Pictograms were generally understandable, but difficulty varied by term: a medical doctor was easy to depict, whereas infusion therapy was difficult. In the full timeline, icons were accompanied by annotations or a legend, so their meaning did not have to be guessed in isolation. Context mattered.
The later account of the project reported abstract pictograms performing as well as, and sometimes better than, realistic comics or photographs across age groups, including older adults.
Comprehension in a simulated consultation
Participants in three groups heard a two-minute therapy explanation modelled on a clinical interview; additional aids differed between the groups. Response quality improved with either visual or text-based support. Responses with the visual aid were slower by seconds, while control-question response times were not significantly different between groups; the researchers interpreted this as consultation of the aid rather than generally slower responding. Participants with visual aids reported more confidence in their answers and greater clarity.
Clinical use and retention
In the clinical evaluation reported in 2024, visual timelines were introduced at the first consultation for patients with haematopoietic disease. Patients and doctors were surveyed separately immediately afterwards, because clinician acceptance was also necessary for adoption in practice. All surveyed doctors were fully or partly happy with the aid, found it useful during the consultation and intended to reuse it. Patients found it helpful for answering content questions and planned to take it home and consult it again.
Eleven patients were surveyed again weeks later; all knew where their copy was, with examples including a fridge, a hanging display and a file, and some reported using it at home. Immediately after the clinical interview, patients answered 80% of content questions correctly. The later account also reported perceived usefulness among patients and physicians and a greater sense of security about treatment.
Only about half the patients found the aid useful for talking with relatives, despite this being a main objective. Some who had not used it in that way had not disclosed their cancer diagnosis to others.
A multicentre randomised study assessing quality of life was proposed as the next step in 2024.